A new way to fight health disparities?

I have another article up at Colorlines today, this time about a new movement in medical education to address health disparities: structural competency training.

For the past few decades, issues of health disparities and race have been approached in medical education by way of cultural competency training. The idea behind cultural competency initially, says Hansen, was listening to the patient and learning about their world view. Instead, she recounted her own cultural competency training during medical school: “Chinese patients tend to like the color red so you might want to prescribe them red tablets. Mexican families like to be together so let them all come into the exam room.” In short, cultural competency training can actually serve to reinforce racial stereotyping by making providers believe they are the experts on a certain community. Instead of approaching someone from a race or culture different than their own with a desire to listen and learn about their world view, the provider might come with a set of predetermined ideas about what that person might need or want. Even if cultural competency training wasn’t reinforcing racial stereotypes, after decades of integration into medical school curricula, there is little evidence that it is effectively addressing the issues it was created to solve.

As an alternative, Hansen and Metzl are proposing that medical students train in structural competency instead. At its core, this training would be a crash course in the social determinants of health, an area that Hansen says has historically been seen as the domain of public health, not medicine. But she and Metzl are out to change that, and Hansen thinks the increased focus on holding providers (and insurance companies) responsible for the outcomes of their patients may help to push this effort along. In a Social Science & Medicine Journal article last year they argue: “clinical training must shift its gaze from an exclusive focus on the individual encounter to include the organization of institutions and policies, as well as of neighborhoods and cities, if clinicians are to impact stigma-related health inequalities.”

The Radical Doula Guide, although I didn’t know of the terminology yet (it was coined by Hansen and Metzl) is in many ways a structural competency primer for doulas. We can’t understand someone’s lived experience without first understanding the social and political systems that influence their lives and their health. The idea of cultural competency has always seemed a bit narrow to me, and I think an education in how racism, poverty, sexism, etc impacts health will be way more useful.

I’ve been obsessed with talking about the extreme disparities faced by women of color when it comes to pregnancy and birth, and I’m trying to spend my time looking at potential solutions to the problem, rather than simply the problem itself.

Here’s to hoping this kind of education becomes the norm for all types of providers–midwives, doctors–and doulas too.

Read the full article here.